TY - JOUR
T1 - Limited cost benefit of lateral interbody fusion for adult spinal deformity surgery
AU - Yamamoto, Tatsuya
AU - Yagi, Mitsuru
AU - Suzuki, Satoshi
AU - Nori, Satoshi
AU - Tsuji, Osahiko
AU - Nagoshi, Narihito
AU - Okada, Eijiro
AU - Fujita, Nobuyuki
AU - Nakamura, Masaya
AU - Matsumoto, Morio
AU - Watanabe, Kota
N1 - Publisher Copyright:
© 2021 Lippincott Williams and Wilkins. All rights reserved.
PY - 2021/1/1
Y1 - 2021/1/1
N2 - Study Design. Retrospective case series. Objective. The aim of this study was to compare the utility and cost-effectiveness of multilevel lateral interbody fusion (LIF) combined with posterior spinal fusion (PSF) (L group) and conventional PSF (with transforaminal lumbar interbody fusion) (P group) in adult spinal deformity (ASD) surgery. Summary of Background Data. The clinical and radiographic outcomes of multilevel LIF for ASD have been reported favorable; however, the cost benefit of LIF in conjunction with PSF is still controversial. Methods. Retrospective comparisons of 88 surgically treated ASD patients with minimum 2-year follow-up from a multicenter database (L group [n=39] and P group [n=49]) were performed. Demographic and radiographic data, health-related quality of life (HRQoL), and the direct hospitalization cost for the initial surgery and 2-year total hospitalization cost were analyzed. Results. Analyses of sagittal spinal alignment showed no significant difference between the two groups at baseline and 2 years post-operation. Surgical time was longer in the L group (L vs. P: 354 vs. 268 minutes, P<0.01), whereas the amount of blood loss was greater in the P group (494 vs. 678 mL, P=0.03). The HRQoL was improved similarly at 2 years post-operation (L vs. P: SRS-22 total score, 3.86 vs. 3.80, P=0.54), with comparable revision rates (L vs. P: 18% vs. 10%, P=0.29). The total direct cost of index surgery was significantly higher in the L group (65,937 vs. 49,849 USD, P<0.01), which was mainly due to the operating room cost, including implant cost (54,466 vs. 41,328 USD, P<0.01). In addition, the 2-year total hospitalization cost, including revision surgery, was also significantly higher in the L group (70,847 vs. 52,560 USD, P<0.01). Conclusion. LIF with PSF is a similarly effective surgery for ASD when compared with conventional PSF. However, due to the significantly higher cost, additional studies on the costeffectiveness of LIF in different ASD patient cohorts are warranted.
AB - Study Design. Retrospective case series. Objective. The aim of this study was to compare the utility and cost-effectiveness of multilevel lateral interbody fusion (LIF) combined with posterior spinal fusion (PSF) (L group) and conventional PSF (with transforaminal lumbar interbody fusion) (P group) in adult spinal deformity (ASD) surgery. Summary of Background Data. The clinical and radiographic outcomes of multilevel LIF for ASD have been reported favorable; however, the cost benefit of LIF in conjunction with PSF is still controversial. Methods. Retrospective comparisons of 88 surgically treated ASD patients with minimum 2-year follow-up from a multicenter database (L group [n=39] and P group [n=49]) were performed. Demographic and radiographic data, health-related quality of life (HRQoL), and the direct hospitalization cost for the initial surgery and 2-year total hospitalization cost were analyzed. Results. Analyses of sagittal spinal alignment showed no significant difference between the two groups at baseline and 2 years post-operation. Surgical time was longer in the L group (L vs. P: 354 vs. 268 minutes, P<0.01), whereas the amount of blood loss was greater in the P group (494 vs. 678 mL, P=0.03). The HRQoL was improved similarly at 2 years post-operation (L vs. P: SRS-22 total score, 3.86 vs. 3.80, P=0.54), with comparable revision rates (L vs. P: 18% vs. 10%, P=0.29). The total direct cost of index surgery was significantly higher in the L group (65,937 vs. 49,849 USD, P<0.01), which was mainly due to the operating room cost, including implant cost (54,466 vs. 41,328 USD, P<0.01). In addition, the 2-year total hospitalization cost, including revision surgery, was also significantly higher in the L group (70,847 vs. 52,560 USD, P<0.01). Conclusion. LIF with PSF is a similarly effective surgery for ASD when compared with conventional PSF. However, due to the significantly higher cost, additional studies on the costeffectiveness of LIF in different ASD patient cohorts are warranted.
KW - Adult spinal deformity
KW - Cost-effectiveness
KW - Lateral interbody fusion
KW - Medical expense
KW - Posterior spinal fusion
KW - Surgery costs
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U2 - 10.1097/BRS.0000000000003703
DO - 10.1097/BRS.0000000000003703
M3 - Article
C2 - 32956251
AN - SCOPUS:85098472124
SN - 0362-2436
VL - 46
SP - 48
EP - 53
JO - Spine
JF - Spine
IS - 1
ER -